Patient education: Preterm labor (The Basics)

What is preterm labor? — 

This is labor that starts before 37 weeks of pregnancy (3 or more weeks before the due date).

Pregnancy normally lasts about 40 weeks, counting from the first day of your last period. Going into labor before 37 weeks of pregnancy can be dangerous. This is because babies who are born preterm, or "premature," can have serious health problems.

What causes preterm labor? — 

It is often hard to know why preterm labor happens. Some things that might cause preterm labor are:

●Bleeding or other problems in the uterus

●Being pregnant with twins, triplets, or more babies

●Infection in the uterus or other part of the body

Who is at risk for preterm labor? — 

It is usually not possible to tell who will go into labor early. But your risk is increased if:

●You had preterm labor and birth in the past.

●You are pregnant with more than 1 baby (such as twins or triplets).

●Your "water breaks" before 37 weeks of pregnancy.

●You have an ultrasound showing that your cervix is short – The cervix is the bottom part of the uterus that leads to the vagina (figure 1).

●You have too much amniotic fluid – This is called "polyhydramnios."

●You have "placental abruption" – This is when the placenta separates from the uterus and causes vaginal bleeding. (The placenta is the organ that forms between you and your baby during pregnancy.)

Other things that might increase the risk of preterm labor are:

●Using illegal drugs, such as cocaine or amphetamines

●Smoking

●Certain infections (including bladder, kidney, and sexually transmitted infections)

●Vaginal bleeding during early pregnancy

●Having pregnancies close together

●Previous surgery on the cervix

●An abnormally shaped uterus

What are the symptoms of preterm labor? — 

The symptoms are the same as with normal labor:

●Tightening of the uterus, also called "contractions" – Your belly might feel hard during contractions. They eventually become painful.

●Change in the fluid that comes out of your vagina – It might be watery, thick, or bloody.

●Pain or pressure low in your belly or thighs

●Pain in your lower back

●Belly cramps, sometimes with diarrhea

●Your water breaks – This can feel like just a trickle or a big gush of fluid from your vagina.

Some people have "Braxton-Hicks contractions." These are contractions that happen several minutes apart. They are usually not too painful and don't get stronger or more frequent over time. They often go away when you lie down or rest. They are sometimes called "false labor contractions." That's because they don't really mean that you are going into labor.

How do I know if I am in labor? — 

Your doctor, nurse, or midwife will ask about your symptoms. They will examine your cervix and check how often your contractions are happening. There are also tests that can find out what is going on. It might take an hour or 2 to figure out whether you are in preterm labor.

Does preterm labor mean that my baby will be born early? — 

Not always. Some people who have preterm labor end up having their baby at the normal time.

How is preterm labor treated? — 

There are different treatments. The right treatment for you depends on:

●What is causing your labor

●How far along you are in your pregnancy

●How healthy you and your baby are

Depending on your situation, your doctor might give you medicines such as:

●"Tocolytic drugs" – These medicines try to stop or slow down labor. But they do not always work. Or they might work for a while, but then labor starts again. If you give birth early, your health care team can take steps to protect the health of your baby.

●Steroids – You might get steroid medicines, especially if you are less than 34 weeks pregnant. These speed up the growth of your baby's lungs. This will help your baby breathe if they are born early.

●Magnesium sulfate – You might get this medicine if you are less than 32 weeks pregnant. It can help prevent a brain disorder called "cerebral palsy" that could affect the baby.

Sometimes, the doctor or nurse will decide that it is better for the baby to be born early than to try to stop your labor. What is right for you depends on your individual situation.

Can preterm labor be prevented? — 

There is usually no way to prevent preterm labor. But you can do some things to lower your risk, such as avoiding smoking and drugs and medicines not prescribed by your doctor or midwife. It's also important to see your doctor, nurse, or midwife regularly during pregnancy. They will monitor your health and watch for problems that might need treatment.

If you are less than 24 weeks pregnant and an ultrasound shows that you have a short cervix, your doctor might prescribe a hormone called "progesterone." It comes as a tablet or gel you put into your vagina. This can help lower the chances of preterm labor and birth.

Sometimes, people wonder if they need to limit their activity to prevent preterm labor. Doctors do not usually recommend this. But it depends on the situation:

●Physical activity – Doctors recommend that most pregnant people get at least 30 minutes of physical activity on all or most days of the week. But people with certain conditions need to avoid being too active. Talk to your doctor or nurse about how to exercise safely.

●Bedrest – Doctors do not recommend bedrest for most pregnant people. Bedrest usually does not help prevent preterm labor. It can also make a person's health worse. If you need bedrest, your doctor or nurse will tell you.

●Sexual activity – Most pregnant people can safely have sex. But people with certain conditions need to avoid sex. Your doctor or nurse will tell you if you need to avoid sex.

Pay attention to how you are feeling during pregnancy. Stop what you are doing and call your doctor, nurse, or midwife right away if you notice any of the symptoms listed below.

When should I call the doctor? — 

Call your doctor, nurse, or midwife if you have any symptoms that might mean you are going into preterm labor:

●You have more than 6 contractions in 1 hour. (This means that the contractions are 10 minutes apart.)

●You feel pressure in your lower belly, pelvis, or vagina.

●You have mild cramping or a backache.

●You have blood or fluid leaking from your vagina.

●You have increased mucus-like vaginal discharge that might look pink, tan, or red.

More on this topic

Patient education: Preterm prelabor rupture of membranes (The Basics)
Patient education: Cervical insufficiency (The Basics)
Patient education: How to tell when labor starts (The Basics)
Patient education: Labor and childbirth (The Basics)
Patient education: Pregnancy loss (The Basics)
Patient education: When a baby is born premature (The Basics)
Patient education: Having twins (The Basics)
Patient education: Activity during pregnancy (The Basics)
Patient education: Taking medicines during pregnancy (The Basics)
Patient education: Bleeding in late pregnancy (The Basics)

Patient education: Preterm labor (Beyond the Basics)
Patient education: Pregnancy loss (Beyond the Basics)